New Resident Orientation

[new resident year; e.g., “2010-11”]

Revised 6.17.09

Clerkship Title Here

Objectives• Identify rationale for residents as teachers in

clerkships• Describe clerkship, including format and learning

objectives• Define student’s roles and responsibilities• Define resident’s roles and responsibilities

Rationale for Residents as Teachers• Teaching is our professional responsibility

– Professionalism

• Teaching can aid our own learning– Practice-based learning

• Residents have most contact with students– Increased opportunity to observe the students and to be

observed by the students

The ClerkshipPersonnel:• Clerkship Director – XX • Associate Clerkship Director –XX• Coordinator – XX• Administrator - XX

The ClerkshipFormat:• XX weeks

– X weeks in-patient– X weeks ambulatory

• Formal didactic teaching in …XXX…tutorial, house staff conferences, and core curriculum days at NYPH

• Evaluation by ….XXX…shelf exam, tutor and you!– Honors, High Pass, Pass, Fail

The ClerkshipRequirements:

Examples:

• Patient log

• Direct observations

• Clinical evaluation

The ClerkshipSites and Directors:

The ClerkshipGeneral Objectives:

• Act professionally at all times

• Participate in patient care as active team member

• Demonstrate clinical reasoning skills

• Demonstrate critical thinking skills

• Demonstrate self-directed learning

The ClerkshipLearning Objectives:

The ClerkshipLearning and Teaching Venues:• In the clinical setting

• In conferences

• In core lectures

• In tutorial sessions

The ClerkshipWhere is the student?• With you• With the patient• In tutor group• In lecture • At home

The StudentRoles• Learner• Active team member

–Active participation vs. scut–Independent with close supervision

• Liaison between patients and family and team

The StudentResponsibilities as Team Member: • Attends all rounds and conferences with the team• Responsible for XXX “own” patients• Assists in care of all patients

The ResidentRoles:• Teacher• Supervisor• Evaluator• Role model

The Resident as Teacher• Create a nonthreatening learning environment• Set expectations for performance• Promotes self-directed learning

The Resident as Teacher• Teach at the bedside

–Demonstrate–Observe–Provide feedback

• Teach through the day –Think out loud–Include a Teachable Moment–Deliver and assign “mini-lectures”

The Resident as Supervisor• Assign patients and tasks to promote student’s

learning and to integrate them into team• Assure adequate supervision of students as they

provide patient care, including performing procedures

• Co-sign notes or write “agree with” notes within 24 hours

• Co-sign orders

The Resident as SupervisorPhysical exams and procedures: • The student exam does not “count”, you must

examine each patient yourself• Students must be chaperoned when performing

pelvic exams• Students may perform procedures for which they

have been certified with general supervision, other procedures must be performed with direct supervision

The Resident as Supervisor• Students may not accompany monitored patients

off the floor• Students may not administer any meds,

immunizations, or IVF

The Resident as SupervisorNotes and Orders: • Student notes contribute valuable information• Student notes can impact on medical-legal matters• Co-sign all student orders

–Although students can write orders under your direction, these orders cannot be taken off without your co-signature

The Resident as Supervisor• You must read the student note and write your own

note• Every student note must be co-signed or have an

“agree with (med student name)” note signed by the supervising resident within 24 hours

• If you have a difference of opinion with a clinically significant part of the student note, explain this in your note in a neutral manner.

The Resident as Evaluator• Provide ongoing, timely feedback

• Contribute to summative evaluation–Turn in your evaluation forms ASAP!!!–Most students “sometimes exceed expectations”–Comments on specific, observed behaviors are

essential

The Resident as Role Model• You are a walking, talking text book• Hidden curriculum

–That which is learned through role modeling, rather than explicit teaching, through acculturation and assimilation

–Can be more powerful than the “explicit curriculum” of the classroom

Acknowledgments• Lyuba Konapasek, MD